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Baran S, Kirazli G, Pistav Akmese P, Celebisoy N, Kirazli T. Normalization of the Suppression Head Impulse Test (SHIMP) and its correlation with the Head Impulse Test (HIMP) in healthy adults. J Vestib Res 2024; 34:15-28. [PMID: 38217558 DOI: 10.3233/ves-230063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2024]
Abstract
OBJECTIVE In our study, it was aimed to compare vestibulo-ocular reflex (VOR) gain and saccade parameters in HIMP and SHIMP tests between gender, right and left ears, and age groups in healthy adults and to examine the correlation between the tests regarding these parameters. METHODS The study included a total of 100 healthy participants aged 18-65 and without complaints of hearing loss, dizziness, lightheadedness, and/or imbalance. Participants underwent HIMP and SHIMP tests, respectively. RESULTS No significant difference was found in HIMP and SHIMP VOR gain values according to gender and age groups. SHIMP duration was significantly longer in women. VOR gain values were lower in the right ear. HIMP amplitude values were higher and SHIMP amplitude values were lower with increasing age. In older age groups, SHIMP peak velocity and duration values were significantly decreased, while HIMP duration value increased and latency value was longer. In the 1st saccade, a significant difference was obtained between HIMP and SHIMP tests for all saccade parameters. There was a statistically significant positive correlation between the VOR gain values of HIMP and SHIMP tests. CONCLUSIONS The present study showed that VOR gain and saccade parameters obtained in different age groups will be important in determining clinical outcomes in vestibular pathologies.
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Affiliation(s)
- Suheda Baran
- Institute of Health Sciences, Audiology and Speech Disorders, Ege University, Izmir, Turkey
| | - Gulce Kirazli
- Department of Audiology, Faculty of Health Sciences, Ege University, Izmir, Turkey
| | - Pelin Pistav Akmese
- Department of Audiology, Faculty of Health Sciences, Ege University, Izmir, Turkey
| | - Nese Celebisoy
- Department of Neurology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Tayfun Kirazli
- Department of ENT, Faculty of Medicine, Ege University, Izmir, Turkey
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Kirazli G, Emekci T, Inceoglu F, Pistav Akmese P, Celebisoy N. An evaluation of the test-retest reliability of the functional head impulse test in healthy young adults. Eur Arch Otorhinolaryngol 2023; 280:5339-5343. [PMID: 37341762 DOI: 10.1007/s00405-023-08063-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/09/2023] [Indexed: 06/22/2023]
Abstract
AIM To determine the test and retest reliability of the functional head impulse test (fHIT) in healthy young adults. MATERIALS AND METHODS Thirty-three healthy participants (17 women, 16 men) aged 18-30 years were included in the study. Each participant underwent the fHIT twice, 1 week apart, by the same experienced clinician. Intraclass correlation coefficients (ICCs) were used to determine test-retest reliability. RESULTS There was no statistically significant difference between the results of total percentage of correct answer (CA%) of the fHIT obtained in session 1 and session 2 measurements in the lateral, anterior, and posterior semicircular canals (SCCs) (p > 0.05). ICC values for test-retest reliability were found to range from 0.619 to 0.665 for the three semicircular canals (SCCs). CONCLUSION The test-retest reliability of the fHIT device was moderate. Attention, cognition, and fatigue may be the factors reducing reliability. In the diagnosis, follow-up, and rehabilitation processes of vestibular diseases in clinics, changes in the fHIT CA% can be used to assess vestibulo-ocular reflex (VOR) functionality.
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Affiliation(s)
- Gulce Kirazli
- Department of Audiology, Faculty of Health Sciences, Ege University, Izmir, Turkey
| | - Tugba Emekci
- Department of Audiology, Faculty of Health Sciences, Gülhane University of Health Sciences, Ankara, Turkey
| | - Feyza Inceoglu
- Department of Biostatistics, Faculty of Medicine, Malatya Turgut Ozal University, Malatya, Turkey
| | - Pelin Pistav Akmese
- Department of Audiology, Faculty of Health Sciences, Ege University, Izmir, Turkey.
| | - Nese Celebisoy
- Department of Neurology, Faculty of Medicine, Ege University, Izmir, Turkey
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Balayeva F, Kirazlı G, Celebisoy N. Vestibular test results in patients with vestibular migraine and Meniere's Disease. Acta Otolaryngol 2023:1-5. [PMID: 37267063 DOI: 10.1080/00016489.2023.2213723] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/28/2023] [Accepted: 05/03/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Vestibular migraine (VM) and Meniere's Disease (MD) are episodic vestibular disorders, sometimes difficult to differentiate from each other on clinical grounds. OBJECTIVE To evaluate vestibular test results of the two groups that may help in the differential diagnosis. METHODS Twenty-two patients with VM, 21 patients with definite MD and 21 healthy volunteers (HC) were studied. Pure tone hearing thresholds (PTHT), cervical vestibular evoked myogenic potentials (cVEMPs), video head impulse test (vHIT) and functional head impulse test (fHIT) were performed. RESULTS PTHT of the MD-affected ears were significantly higher than VM and HC groups (p < .001 for both) when cVEMP amplitudes were lower (p = .005 for HC), (p = .006 for VM). Lateral canal vHIT gain of the MD-affected ears were lower than VM patients (p = .003) and the HC (p < .001). The percentage of correctly identified optotypes (CA%) on fHIT was low for both patient groups when compared with the HC (p < .001). CONCLUSION In addition to hearing loss, low cVEMP amplitudes on the affected side with decreased gain on vHIT indicate disturbed saccular and lateral semicircular canal functions in MD patients differentiating them from VM. A functional deficit in gaze stabilization detected by fHIT is the only abnormality found in patients with VM.
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Affiliation(s)
- Fidan Balayeva
- Department of Neurology, Ege University Medical School, Bornova, Izmir, Turkey
| | - Gülce Kirazlı
- Department of Audiology, Ege University Faculty of Health Sciences, Izmir, Turkey
| | - Nese Celebisoy
- Department of Neurology, Ege University Medical School, Bornova, Izmir, Turkey
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Uyaroglu F, Sariteke R, Celebisoy N. Can vestibular-evoked myogenic potentials be used in the assessment of reflex habituation? A preliminary report. NEUROL SCI NEUROPHYS 2023. [DOI: 10.4103/nsn.nsn_149_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
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Kaçan M, Kirazlı G, Balayeva F, Celebisoy N. Recurrent Vestibulopathy: Comparison of Vestibular Test Results with Ménière’s Disease and Vestibular Migraine. Audiol Neurootol 2022; 28:116-127. [PMID: 36323266 DOI: 10.1159/000526814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/14/2022] [Indexed: 11/07/2022] Open
Abstract
<b><i>Introduction:</i></b> Recurrent and episodic vestibular symptoms not fulfilling criteria for known episodic vestibular syndromes are named as recurrent vestibulopathy (RV). We aimed to compare the vestibular test results of RV patients with vestibular migraine (VM) and Ménière’s disease (MD). <b><i>Methods:</i></b> Twenty patients with MD, 20 patients with VM, 18 patients with RV, and 20 healthy volunteers (HC) were evaluated. Pure-tone hearing thresholds (PTHTs), video head impulse test (vHIT), functional head impulse test (fHIT), and cervical vestibular evoked myogenic potentials (cVEMPs) were studied. <b><i>Results:</i></b> PTHT of the MD-affected ears were significantly high, and cVEMP-corrected amplitudes were low when compared with the VM, RV, and HC (<i>p</i> < 0.001 for all). Amplitude asymmetry ratio was significantly high in MD-affected ears when compared with the HC (<i>p</i> = 0.014), VM (<i>p</i> = 0.038), and RV (<i>p</i> = 0.045). VEMP latencies and lateral canal vHIT gain were not different between groups (<i>p</i> > 0.05). The percentage of correctly identified optotypes on fHIT of the MD (<i>p</i> > 0.001), VM (<i>p</i> = 0.004), and RV (<i>p</i> = 0.001) patients were low in comparison with the HC. <b><i>Conclusion:</i></b> Apart from hearing loss, low cVEMP amplitudes on the affected side were the main feature in MD differentiating it from VM and RV. Vestibular test results of patients with RV and VM were similar. Low fHIT results in all groups indicate a functional deficit in gaze stabilization. Disabling vertigo attacks disturbing attention may be the cause of this functional impairment. MD, VM, and RV may be parts of a broad-spectrum disorder, RV patients representing milder forms not associated with cochlear or migrainous features.
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Affiliation(s)
- Melis Kaçan
- Department of Clinical Neuroscience, Ege University Institute of Health Sciences, Izmir, Turkey
| | - Gülce Kirazlı
- Department of Audiology, Ege University Faculty of Health Sciences, Izmir, Turkey
| | - Fidan Balayeva
- Department of Neurology, Ege University Medical School, Izmir, Turkey
| | - Nese Celebisoy
- Department of Clinical Neuroscience, Ege University Institute of Health Sciences, Izmir, Turkey
- Department of Neurology, Ege University Medical School, Izmir, Turkey
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Demirhan MA, Celebisoy N. Cognitive functions in episodic vestibular disorders: Meniere's disease and vestibular migraine. J Vestib Res 2022; 33:63-70. [PMID: 36120750 DOI: 10.3233/ves-220025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cognitive deficits have been defined in patients with bilateral and unilateral vestibular loss. OBJECTIVE To investigate cognitive functions in patients with episodic vestibular disorders. METHODS Nineteen patients with Meniere's disease (MD), 19 patients with vestibular migraine (VM) and 21 age and education matched healthy controls were studied. Mini Mental State Examination assessing global mental status, Reading Span Test and the Stroop Test evaluating working memory, cognitive processing, reading comprehension and attention, Trail Making Test and Benton's Judgment of Line Orientation Test investigating visual processing, visuospatial skills, processing speed were used. Beck depression and anxiety inventories were given to evaluate the emotional status. RESULTS Cognitive test results of the MD and VM patients were not significantly different from the healthy controls (p > 0.05) as well as Beck depression scores (p = 0.14). Beck anxiety scores showed significant difference (p = 0.003). VM patients had significantly higher scores than the healthy controls (p = 0.002) on pairwise comparisons. The scores of the MD patients did not reach statistical significance (p = 0.15). CONCLUSION Episodic vestibular disorders like MD and VM without inter-ictal vestibular deficits do not seem to be associated with cognitive impairment. Patients with VM have significantly higher anxiety scores than the healthy controls and MD patients.
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Affiliation(s)
- Mehmet Alp Demirhan
- Department of Clinical Neuroscience, Ege University Institute of Health Sciences, Izmir, Turkey
| | - Nese Celebisoy
- Department of Clinical Neuroscience, Ege University Institute of Health Sciences, Izmir, Turkey.,Department of Neurology, Ege University Medical School, Bornova, Izmir, Turkey
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Aykur M, Dirim Erdogan D, Selvi Gunel N, Guler A, Biray Avci C, Celebisoy N, Gunduz C, Dagci H. Genotyping and Molecular Identification of Acanthamoeba Genotype T4 and Naegleria fowleri from Cerebrospinal Fluid Samples of Patients in Turkey: Is it the Pathogens of Unknown Causes of Death? Acta Parasitol 2022; 67:1372-1383. [PMID: 35864411 DOI: 10.1007/s11686-022-00597-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 07/07/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE This study was aimed to investigate the presence of pathogenic free-living amoebae (FLA) in suspected cases of meningoencephalitis with unknown causes of death in Turkey. METHOD A total of 92 patients, who were diagnosed as meningoencephalitis, were enrolled. All cerebrospinal fluid (CSF) samples were directly microscopically examined and cultured. Acanthamoeba, N. fowleri and B. mandrillaris were further investigated using molecular diagnostic tools including real-time PCR, sequencing, and phylogenetic analyses. RESULTS The examined CSF samples were not found positive for the presence of FLA by microscopic examination and culture method. However, two CSF samples were detected positive by real-time PCR assay. Of the positive CSF samples, one was identified as Acanthamoeba genotype T4 and the second positive sample was identified as N. fowleri belonging to genotype II. Furthermore, the pathogens diagnoses was verified through Sanger sequencing. CONCLUSION This study was significant to report the presence of Acanthamoeba genotype T4 and N. fowleri genotype II in CSF samples by real-time PCR assay. The present study shows the significance of primary amoebic meningoencephalitis (PAM) and granulomatous amoebic encephalitis (GAE) as one of the differential diagnoses to be considered by clinicians during the evaluation of suspected meningoencephalitis or cases of unknown cause in Turkey. Using real-time PCR, this has made the rapid detection, in a short time-frame, of Acanthamoeba and N. fowleri in CSF samples from patients. The problems with qPCR is that it is not available in every laboratory, reagents are expensive, and it requires skilled and expert personnel to set up these assays.
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Affiliation(s)
- Mehmet Aykur
- Department of Parasitology, Faculty of Medicine, Ege University, Bornova/İzmir, Turkey. .,Department of Parasitology, Faculty of Medicine, Tokat Gaziosmanpaşa University, PO Box 60030, Tokat, Turkey.
| | - Derya Dirim Erdogan
- Department of Parasitology, Faculty of Medicine, Ege University, Bornova/İzmir, Turkey
| | - Nur Selvi Gunel
- Department of Medical Biology, Faculty of Medicine, Ege University, Bornova/İzmir, Turkey
| | - Ayse Guler
- Department of Neurology, Faculty of Medicine, Ege University, Bornova/İzmir, Turkey
| | - Cigir Biray Avci
- Department of Medical Biology, Faculty of Medicine, Ege University, Bornova/İzmir, Turkey
| | - Nese Celebisoy
- Department of Neurology, Faculty of Medicine, Ege University, Bornova/İzmir, Turkey
| | - Cumhur Gunduz
- Department of Medical Biology, Faculty of Medicine, Ege University, Bornova/İzmir, Turkey
| | - Hande Dagci
- Department of Parasitology, Faculty of Medicine, Ege University, Bornova/İzmir, Turkey
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8
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Uyaroglu FG, Ucar R, Acarer A, Celebisoy N. What might cervical vestibular-evoked myogenic potential abnormalities mean in essential tremor? Neurol Sci 2021; 42:5271-5276. [PMID: 33860393 DOI: 10.1007/s10072-021-05248-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 04/10/2021] [Indexed: 10/21/2022]
Abstract
AIM/BACKGROUND Essential tremor (ET) is one of the most common movement disorders. However, its pathogenesis is unclear. Human vestibular reflexes are essential not only for gait and posture but also for goal-directed voluntary movements. In this study, cervical vestibular-evoked myogenic potentials (cVEMPs), the electrophysiological equivalent of the vestibulo-collic reflex was studied in ET patients to understand the interaction between the tremor network and the vestibular neural pathways. METHODS cVEMPs were recorded in 40 ET patients and 40 age and sex-matched healthy controls (HCs). The latencies of peaks p13 and n23 and peak-to-peak amplitude of p13-n23 were measured. RESULTS There was no statistically significant difference between the p13 latencies of the HC and ET groups (p 0.79 and p 0.23 for the right and left sides respectively). n23 latency was shortened bilaterally in the ET group (p 0.009 and p 0.02 for the right and left sides respectively). p13-n23 amplitudes of the ET patients were bilaterally reduced when compared with the HC (p <0.001 and p 0.001 for the right and left sides respectively). CONCLUSION Information provided by vestibular afferents is crucial in the control of voluntary movements in humans. Despite this silent but significant effect, the role of the vestibular system in movement disorders is often overlooked. In this study, it was found that cVEMP responses reflecting the activity of the vestibulo-collic pathway were affected in ET which can be either caused by dysfunctional structures or pathways responsible from ET or an additional disorder of vestibular information processing in these patients.
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Affiliation(s)
- Feray Gulec Uyaroglu
- Department of Neurology, Izmir Tepecik Education and Research Hospital, Izmir, Turkey
| | - Roza Ucar
- Department of Neurology, Izmir Tepecik Education and Research Hospital, Izmir, Turkey
| | - Ahmet Acarer
- Department of Neurology and Clinical Neurophysiology, Ege University Medical School, Bornova, 35100, Izmir, Turkey
| | - Nese Celebisoy
- Department of Neurology and Clinical Neurophysiology, Ege University Medical School, Bornova, 35100, Izmir, Turkey.
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Karti O, Top Karti D, Ayhan Z, Celebisoy N, Saatci AO. Bilateral Congenital Prepapillary Retinal Arterial Loop. Neuroophthalmology 2020; 44:344-348. [PMID: 33012926 DOI: 10.1080/01658107.2019.1680704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Prepapillary vascular loops are rare congenital vascular abnormalities of the retinal vasculature. This mostly benign condition can sometimes cause complications such as branch retinal artery occlusion and vitreous haemorrhage. Disc collaterals, neovascularisation of the optic disc, idiopathic retinal vasculitis, aneurysms and neuroretinitis (IRVAN) syndrome and Wyburn Mason syndrome should be kept in mind for the vascular differential diagnosis. In addition, when the loops present bilaterally and settle into the region adjacent to the optic disc border, they can be misdiagnosed as papilloedema. The diagnosis is usually made clinically by careful fundus examination. Optical coherence tomography and fundus fluorescein angiography might serve as ancillary tools for the diagnosis. In this report, we present a 52-year-old male with bilateral prepapillary arterial loops referred to our clinic with a preliminary diagnosis of papilloedema.
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Affiliation(s)
- Omer Karti
- Department of Ophthalmology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Dilek Top Karti
- Department of Neurology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Ziya Ayhan
- Department of Ophthalmology, Dokuz Eylul University Medical Faculty, Izmir, Turkey
| | - Nese Celebisoy
- Department of Neurology, Ege University Medical Faculty, Izmir, Turkey
| | - Ali Osman Saatci
- Department of Ophthalmology, Dokuz Eylul University Medical Faculty, Izmir, Turkey
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Korkmaz A, Top Karti D, Unsal Bilgin YO, Karti O, Celebisoy N. Bilateral Optic Neuropathy Revealing Chronic Hepatitis B Infection: A Report of A Rare Case. Neuroophthalmology 2020; 45:403-406. [PMID: 34720272 DOI: 10.1080/01658107.2020.1806888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Hepatitis B virus (HBV) infection is a major public health problem. Liver diseases such as cirrhosis and hepatocellular carcinoma are the main causes of mortality and morbidity associated with this viral infection. Ocular manifestations may also arise during the course of HBV infection. We herein present a 44-year-old male with bilateral optic neuropathy revealing chronic HBV infection.
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Affiliation(s)
- Anil Korkmaz
- Department of Ophthalmology, Bingol State Hospital, Bingöl, Turkey
| | - Dilek Top Karti
- Department of Neurology, Izmir Bozyaka Training and Research Hospital, İzmir, Turkey
| | | | - Omer Karti
- Department of Ophthalmology, İzmir Democracy University, İzmir, Turkey
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Top Karti D, Aktert D, Celebisoy N. Isolated Internal Ophthalmoplegia Secondary to Herpes Zoster Ophthalmicus: A Rare Case Report. Neuroophthalmology 2020; 44:118-120. [PMID: 32395161 DOI: 10.1080/01658107.2019.1618343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 05/09/2019] [Indexed: 10/26/2022] Open
Abstract
Herpes zoster becomes latent in the sensory ganglia after the primary infection and may reactivate many years later to produce shingles in adults. Involvement of the ophthalmic branch of the trigeminal nerve with this virus is called Herpes zoster ophthalmicus (HZO). The eyelid skin, cornea, uvea, retina, optic nerve and other cranial nerves can be affected by HZO. Isolated internal ophthalmoplegia can rarely be seen. Clinicians should be aware of this condition and HZO must be kept in mind in the differential diagnosis of anisocoria.
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Affiliation(s)
- Dilek Top Karti
- Department of Neurology, Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Dilara Aktert
- Department of Neurology, Ege University, İzmir, Turkey
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12
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Karti O, Ozdemir O, Top Karti D, Zengin MO, Tatli S, Kusbeci T, Celebisoy N. Orbital Metastasis Secondary to Breast Cancer: A Rare Cause of Unilateral External Ophthalmoplegia. Neuroophthalmology 2020; 45:181-183. [PMID: 34188339 DOI: 10.1080/01658107.2019.1704030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Orbital metastases are rare causes of orbital tumours, and may present with pain, photophobia, red eye, vision loss, diplopia, proptosis, or external ophthalmoplegia. Breast cancer is responsible for a great majority of orbital metastases. Herein, we report a 78-year-old female who had unilateral external ophthalmoplegia due to orbital metastasis of primary breast cancer.
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Affiliation(s)
- Omer Karti
- Department of Ophthalmology, İzmir Democracy University, Izmir, Turkey
| | - Ozlem Ozdemir
- Department of Medical Oncology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Dilek Top Karti
- Department of Neurology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Mehmet Ozgur Zengin
- Department of Ophthalmology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Sertac Tatli
- Department of Ophthalmology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Tuncay Kusbeci
- Department of Ophthalmology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Nese Celebisoy
- Department of Neurology, Ege University Medical Faculty, Izmir, Turkey
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Top Karti D, Karti O, Koc AM, Esen O, Celebisoy N. Unilateral Abducens Nerve Palsy with Ipsilateral Horner's Syndrome as an Initial Manifestation of Recurrent Nasopharyngeal Carcinoma. Neuroophthalmology 2019; 44:379-383. [PMID: 33328696 DOI: 10.1080/01658107.2019.1625931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
A 62-year-old man was admitted to our clinic with a two-week history of double vision. Neuro-ophthalmological examination showed a left abducens nerve palsy with an ipsilateral Horner's syndrome. Neuro-imaging identified recurrent nasopharyngeal carcinoma explaining the clinical findings. Co-existence of unilateral abducens nerve palsy and ipsilateral Horner's syndrome is very rare and localises to the posterior cavernous sinus. Therefore, clinicians should be aware of this rare co-existence and perform appropriate neuro-imaging to clarify the underlying aetiology.
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Affiliation(s)
- Dilek Top Karti
- Department of Neurology, Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Omer Karti
- Department of Ophthalmology, Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Ali Murat Koc
- Department of Radiology, Bozyaka Training andResearch Hospital, İzmir, Turkey
| | - Ozgur Esen
- Department of Radiology, Bozyaka Training andResearch Hospital, İzmir, Turkey
| | - Nese Celebisoy
- Department of Neurology, Ege University Hospital, İzmir, Turkey
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14
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Tata G, Kisabay A, Gokcay F, Celebisoy N. Idiopathic intracranial hypertension: Are there predictors for visual outcome or recurrences? Clin Neurol Neurosurg 2019; 183:105378. [PMID: 31176933 DOI: 10.1016/j.clineuro.2019.105378] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 05/12/2019] [Accepted: 05/23/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To find out the predictors of final visual outcome and recurrences in idiopathic intracranial hypertension (IIH). PATIENTS AND METHODS Medical records of 75 patients with IIH were analyzed retrospectively. Gender, age of disease onset (AODO), body mass index (BMI), lumbar puncture opening pressure (LP-OP), visual acuity (VA) in logMAR, optical disc appearance (ODA), visual field (VF) mean deviation (MD), treatment results and recurrence rates were considered. RESULTS Mean age at onset age was 32.4 years, BMI was 311 kg/m² and median LP-OP was 380 mm H2O. All patients were treated with acetazolamide with a median dose of 1500 mg. The mean follow-up period was 44.8 months. AODO, BMI, LP-OP were not correlated with any of the examination parameters (VA, ODA, VF) at the first or last visit. The correlation between the VA and VF both at the first and last visit was not very powerful. VA of the last visit was fairly correlated with the VA of the first visit. However, the correlation between the last and first visit VF was very good. A very significant improvement in both VA and VF was recorded after treatment. Recurrences were noted in 23%. Demographic and clinical features of the recurring and non-recurring patients were not significantly different in terms of AODO, BMI, LP-OP, VA, VF or ODA. CONCLUSIONS The patients with IIH respond to treatment with acetazolamide. First visit VF is the main determinant of the final visual outcome. Recurrences cannot be predicted by the demographic or clinical features at presentation.
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Affiliation(s)
- Gulten Tata
- Şişli Hamidiye Etfal Training and Research Hospital, Department of Neurology, Istanbul, Turkey
| | - Aysin Kisabay
- Celal Bayar University Medical School, Department of Neurology, Manisa, Turkey
| | - Figen Gokcay
- Ege University Medical School, Department of Neurology, Bornova, Izmir, Turkey
| | - Nese Celebisoy
- Ege University Medical School, Department of Neurology, Bornova, Izmir, Turkey.
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Kaya I, Eraslan S, Tarhan C, Bilgen C, Kirazli T, Gokcay F, Karapolat H, Celebisoy N. Can verapamil be effective in controlling vertigo and headache attacks in vestibular migraine accompanied with Meniere's disease? A preliminary study. J Neurol 2019; 266:62-64. [PMID: 30989371 DOI: 10.1007/s00415-019-09309-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/28/2019] [Accepted: 04/02/2019] [Indexed: 01/03/2023]
Affiliation(s)
- Isa Kaya
- Department of Otolaryngology, Ege University Medical School, Izmir, Turkey
| | - Sevinc Eraslan
- Department of Otolaryngology, Ege University Medical School, Izmir, Turkey
| | - Ceyda Tarhan
- Department of Otolaryngology, Iğdır State Hospital, Iğdır, Turkey
| | - Cem Bilgen
- Department of Otolaryngology, Ege University Medical School, Izmir, Turkey
| | - Tayfun Kirazli
- Department of Otolaryngology, Ege University Medical School, Izmir, Turkey
| | - Figen Gokcay
- Department of Neurology, Ege University Medical School, Bornova, 35100, Izmir, Turkey
| | - Hale Karapolat
- Department of Physical Therapy and Rehabilitation, Ege University Medical School, Izmir, Turkey
| | - Nese Celebisoy
- Department of Neurology, Ege University Medical School, Bornova, 35100, Izmir, Turkey.
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Top Karti D, Karti O, Gokcay F, Celebisoy N. Acute effect of caffeine on pattern-reversal visual evoked potential: a randomized-controlled study. Cutan Ocul Toxicol 2019; 38:249-252. [PMID: 30793994 DOI: 10.1080/15569527.2019.1583248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: This study was aimed to investigate the acute effect of caffeine intake on pattern-reversal (PR) visual evoked potential (VEP). Methods: This randomized controlled study included 40 participants who were divided into two groups randomly (group 1 [study group, n = 20] and group 2 [control group, n = 20]). While the study group received coffee beverages made from 6 g pure coffee beans (36 mg of caffeine per gram) containing approximately 216 mg caffeine, the control group was given beverages containing 200 mg lactose without caffeine. PR-VEP test was performed at baseline and 1 h after the beverage intake. The right eyes of both groups were used for the statistical analysis. Results: The median age of group 1 (8 male and 12 female) and group 2 (7 male and 13 female) were 31.0 (range, 21-59) and 36.5 (range, 20-59) years, respectively. No statistically significant difference was found between two groups in terms of age (p = 0.398) and gender (p = 0.744). Before the caffeine intake, median P100 latency and amplitudes were 109.90 ms (range: 99.60-120.60) and 12.45 µV (range: 5.20-19.30), respectively. One hour after caffeine intake, corresponding values were 110.70 ms (range: 99.00-114.60) and 12.45 µV (range: 5.70-20.0). Baseline P100 latency and amplitude values were not significantly different from the values recorded 1 h after caffeine intake (p > 0.05). Conclusions: This study showed that ingesting moderate amounts of caffeine did not affect PR-VEP parameters. Therefore, caffeine restriction does not seem to be required before the PR-VEP test. Further studies are needed to confirm our findings.
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Affiliation(s)
- Dilek Top Karti
- a Department of Neurology, Bozyaka Training and Research Hospital , Izmir , Turkey
| | - Omer Karti
- b Department of Ophthalmology, Bozyaka Training and Research Hospital , Izmir , Turkey
| | - Figen Gokcay
- c Department of Neurology, Medical Faculty, Ege University, Izmir , Turkey
| | - Nese Celebisoy
- c Department of Neurology, Medical Faculty, Ege University, Izmir , Turkey
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Celebisoy M, Celebisoy N. Ptosis and Elevation Paresis Due to Mesencephalic Infarction. Neuroophthalmology 2019; 43:56-57. [PMID: 30723527 DOI: 10.1080/01658107.2018.1458887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 03/23/2018] [Accepted: 03/26/2018] [Indexed: 10/16/2022] Open
Abstract
Lesions located in the anterior cavernous sinus or posterior orbit are known to cause divisional oculomotor palsy. We herein report a patient with fascicular infarction causing superior division paresis of the nerve.
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Affiliation(s)
- Mehmet Celebisoy
- Department of Neurology, Atatürk Training and Research Hospital, İzmir, Turkey
| | - Nese Celebisoy
- Medical School Department of Neurology, Ege University, Bornova, Izmir, Turkey
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Guler A, Karbek Akarca F, Eraslan C, Tarhan C, Bilgen C, Kirazli T, Celebisoy N. Clinical and video head impulse test in the diagnosis of posterior circulation stroke presenting as acute vestibular syndrome in the emergency department. J Vestib Res 2018; 27:233-242. [PMID: 29081427 DOI: 10.3233/ves-170620] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Head impulse test (HIT) is the critical bedside examination which differentiates vestibular neuritis (VN) from posterior circulation stroke (PCS) in acute vestibular syndrome (AVS). Video-oculography based HIT (vHIT) may have aadditional strength in making the differentiation. METHODS Patients admitted to the emergency department of a tertiary-care medical center with AVS were studied. An emergency specialist and a neurologist performed HIT. vHIT was conducted by an neuro-otology research fellow. RESULTS Forty patients 26 male, 14 female with a mean age of 49 years were included in the analyses. Final diagnoses were VN in 24 and PCS in 16 patients.In the VN group, clinical HIT was assessed as abnormal in 19(80%) cases by the emergency specialist and in 20(83%) by the neurologist. In all PCS patients, HIT was recorded as normal both by the emergency specialist and the neurologist (100%).On vHIT, patients with VN had significantly low gain values for both the ipsilesional and contralesional sides when compared with the healthy controls, with significantly lower figures for the ipsilesional side (p < 0.001). All patients in this group had normal DWI-MRI.PCS patients had bilaterally low gain (p < 0.05) on vHIT. However, gain asymmetry was not significant. Subgroup analyses according to presence of brainstem involvement revealed bilateral low gain (p < 0.05) in patients with brainstem infarction (anterior inferior cerebellar artery-posterior inferior cerebellar artery stroke, AICA-PICA stroke) whereas patients with pure cerebellar infarction (posterior inferior cerebellar artery-superior cerebellar artery stroke, PICA-SCA stroke) had gain values similar to healthy controls.With a gain cut-off ≤0.75 and gain asymmetry cut-off ≥17%, as determined by ROC analysis, 100% of PCS patients and 80% of VN patients were correctly diagnosed. CONCLUSIONS Clinical HIT, either performed by an emergency specialist or neurologist is equivalent to vHIT gain and gain asymmetry analysis as conducted by neuro-otologist in the diagnosis of PCS, albeit mislabeling about 20% of VN patients. vHIT does not appear to yield additional diagnostic information. These findings indicate the strength of clinical HIT. Pure gain-based vHIT analysis seems limited and needs to be incorporated with saccade analysis.
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Affiliation(s)
- Ayse Guler
- Department of Neurology, Ege University School of Medicine, Bornova, Izmir, Turkey
| | - Funda Karbek Akarca
- Department of Emergency, Ege University School of Medicine, Bornova, Izmir, Turkey
| | - Cenk Eraslan
- Department of Radiology, Ege University School of Medicine, Bornova, Izmir, Turkey
| | - Ceyda Tarhan
- Department of Otorhinolaryngology, Ege University School of Medicine, Bornova, Izmir, Turkey
| | - Cem Bilgen
- Department of Otorhinolaryngology, Ege University School of Medicine, Bornova, Izmir, Turkey
| | - Tayfun Kirazli
- Department of Otorhinolaryngology, Ege University School of Medicine, Bornova, Izmir, Turkey
| | - Nese Celebisoy
- Department of Neurology, Ege University School of Medicine, Bornova, Izmir, Turkey
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Grill E, Akdal G, Becker-Bense S, Hübinger S, Huppert D, Kentala E, Strobl R, Zwergal A, Celebisoy N. Multicenter data banking in management of dizzy patients: first results from the DizzyNet registry project. J Neurol 2018; 265:3-8. [PMID: 29663119 DOI: 10.1007/s00415-018-8864-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/08/2018] [Accepted: 04/09/2018] [Indexed: 01/03/2023]
Abstract
PURPOSE Comprehensive phenotypical data across countries is needed to understand the determinants, prognosis and consequences of vestibular disease. The registry is a data repository for the members of the European DizzyNet. We report results from a pilot study using data from Turkey and Germany. METHODS The pilot study included a convenience sample of patients aged 18 or above referred to Ege University Medical School Hospital, Dokuz Eylül University Hospital, Izmir, Turkey, and the German Center for German Center for Vertigo and Balance Disorders, University on Munich, Germany, with symptoms of vertigo or dizziness. Health-related quality of life was assessed with the EQ5-D and the Dizziness Handicap Inventory (DHI). To obtain comparable groups we matched data from the two countries for age, sex and diagnosis by propensity score. RESULTS We included 80 adult patients, 40 from each country (60% female, mean age 54.1, SD 12.4). Matching was successful. Vestibular migraine (34%) was the most frequent diagnosis, followed by benign paroxysmal positional vertigo (29%) and Menière's disease (12%). Clinical signs and symptoms were comparable in both countries. Patients from Turkey were more likely to report headaches (65 vs. 32%) and to show gait unsteadiness (51 vs. 5%). Patients from Germany reported significantly higher quality of life and lower values of the DHI score. CONCLUSIONS Sharing data facilitates research, enhances translation from basic science into clinical applications, and increases transparency. The DizzyNet registry is a first step to data sharing in vestibular research across Europe.
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Affiliation(s)
- Eva Grill
- Institute for Medical Information Processing, Biometrics and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistr 17, 81377, Munich, Germany.
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.
- Munich Center of Health Sciences, Ludwig-Maximilians-Universität München, Munich, Germany.
| | - Gülden Akdal
- Department of Neurology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Sandra Becker-Bense
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Steffen Hübinger
- Institute for Medical Information Processing, Biometrics and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistr 17, 81377, Munich, Germany
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Doreen Huppert
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
- Institute for Clinical Neurosciences, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Erna Kentala
- Department of Otorhinolaryngology, University of Helsinki, Helsinki, Finland
| | - Ralf Strobl
- Institute for Medical Information Processing, Biometrics and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistr 17, 81377, Munich, Germany
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Andreas Zwergal
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
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Celebisoy N. Acute vestibular syndrome: clinical head impulse test versus video head impulse test. J Neurol 2018; 265:44-47. [PMID: 29508131 DOI: 10.1007/s00415-018-8804-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/15/2018] [Accepted: 02/19/2018] [Indexed: 11/26/2022]
Abstract
HINTS battery involving head impulse test (HIT), nystagmus, and test of skew is the critical bedside examination to differentiate acute unilateral peripheral vestibulopathy from posterior circulation stroke (PCS) in acute vestibular syndrome (AVS). The highest sensitivity component of the battery has been reported to be the horizontal HIT, whereas skew deviation is defined as the most specific but non-sensitive sign for PCS. Video-oculography-based HIT (vHIT) may have an additional power in making the differentiation. If vHIT is undertaken, then both gain and gain asymmetry should be taken into account as anterior inferior cerebellar artery (AICA) strokes are at risk of being misclassified based on VOR gain alone. Further refinement in video technology, increased operator proficiency and incorporation with saccade analysis will increase the sensitivity of vHIT for PCS diagnosis. For the time being, clinical examination seems adequate in frontline diagnostic evaluation of AVS.
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Affiliation(s)
- Nese Celebisoy
- Department of Neurology, Ege University Medical School, 35100, Bornova, Izmir, Turkey.
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Karti O, Karti DT, Kilic İH, Gokcay F, Celebisoy N. Baseline demographics, clinical features, and treatment protocols of 240 patients with optic neuropathy: experiences from a neuro-ophthalmological clinic in the Aegean region of Turkey. Int Ophthalmol 2017; 39:155-166. [PMID: 29260500 DOI: 10.1007/s10792-017-0799-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 12/11/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To analyze the demographic patterns, clinical characteristics, and treatment protocols of optic neuropathies. MATERIALS AND METHODS The hospital data of patients with optic neuropathy admitted to the Department of Neuro-ophthalmology in a tertiary referral center in Turkey between January 2010 to January 2017 were retrospectively analyzed. Demographic patterns, clinical features, treatment protocols, and the natural disease courses were assessed. RESULTS The total number of patients with optic neuropathy seen over this period was 240, which consist of 43 with idiopathic optic neuritis (17.9%), 40 with multiple sclerosis-related optic neuritis (16.7%), 12 with chronic relapsing inflammatory optic neuritis (5.0%), 12 with atypical optic neuritis (5.0%), 11 with neuromyelitis optica spectrum disorders-related optic neuritis (4.6%), 90 with non-arteritic ischemic optic neuropathy (37.5%), 4 with arteritic ischemic optic neuropathy (1.7%), 10 with traumatic optic neuropathy (4.1%), 6 with compressive optic neuropathy (2.5%), and 12 with mitochondrial optic neuropathy [9 with toxic optic neuropathy (3.7%) and 3 with Leber's hereditary optic neuropathy (1.2%)]. There were 101 males (42%) and 139 females (58%). The mean age was 43.34 ± 15.86 years. CONCLUSION This study reported the demographics, clinical characteristics, and treatment protocols of optic neuropathies in a neuro-ophthalmology specialty clinic at a tertiary referral center in Turkey during the past decade. The data may be useful in assessing the global status of optic neuropathies.
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Affiliation(s)
- Omer Karti
- Department of Ophthalmology, Bozyaka Training and Research Hospital, Saim Cıkrıkcı cad. No: 59, Bozyaka, Izmir, Turkey.
| | - Dilek Top Karti
- Department of Neurology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - İlay Hilal Kilic
- Department of Neurology, Ege University Medical Faculty, Izmir, Turkey
| | - Figen Gokcay
- Department of Neurology, Ege University Medical Faculty, Izmir, Turkey
| | - Nese Celebisoy
- Department of Neurology, Ege University Medical Faculty, Izmir, Turkey
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Ciftci S, Guler A, Deveci E, Celebisoy N, Yuceyar N. A case with hyperammonemic encephalopathy triggered by single dose valproate. Neurol Sci 2016; 37:2017-2018. [PMID: 27436290 DOI: 10.1007/s10072-016-2673-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 07/13/2016] [Indexed: 11/24/2022]
Affiliation(s)
- S Ciftci
- Neurology Department, Ege University Faculty of Medicine, Izmir, Turkey.
| | - A Guler
- Neurology Department, Ege University Faculty of Medicine, Izmir, Turkey
| | - E Deveci
- Neurology Department, Ege University Faculty of Medicine, Izmir, Turkey
| | - N Celebisoy
- Neurology Department, Ege University Faculty of Medicine, Izmir, Turkey
| | - N Yuceyar
- Neurology Department, Ege University Faculty of Medicine, Izmir, Turkey
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Affiliation(s)
- N Celebisoy
- Ege University Medical School Department of Neurology, ýzmir 35100, Turkey
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Acarer A, Karapolat H, Celebisoy N, Ozgen G, Colakoglu Z. Is customized vestibular rehabilitation effective in patients with Parkinson's? NeuroRehabilitation 2016; 37:255-62. [PMID: 26484517 DOI: 10.3233/nre-151258] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients with Parkinson's disease complain about restrictions in their daily life activities and impairment in their mobility and balance. OBJECTIVE The aim of this study was to compare the effects of vestibular rehabilitation on functioning, quality of life, balance, and postural stability in patients with Parkinson's disease. METHODS The patients with Parkinson's disease divided into a rehabilitation group (Group 1, n: 29) and a control group(Group 2, n: 11). All patients were evaluated before and after eight weeks of customized vestibular rehabilitation for motor score (Unified Parkinson's Disease Rating Scale); quality of life (Parkinson's Disease Questionnaire-39); balance (Activities-Specific Balance Confidence Scale [ABC], Timed Up and Go Test, Dynamic Gait Index [DGI], and Berg Balance Scale [BBS]); and postural stability (Modified Clinical Test for Sensory Interaction on Balance [mCTSIB]. RESULTS There were significant differences in the pre- and post-exercise ABC, BBS, and DGI scores in Group 1 (p < 0.05). A statistically significant impairment was observed in mCTSIB (firm and foam eyes closed [EC]) in the control group (p < 0.05). There were no significant intergroup differences in any of the parameters evaluated (p > 0.05). CONCLUSION In this study, vestibular rehabilitation was found to be effective for improving balance in patients with Parkinson's disease.
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Alakbarova N, Eraslan C, Celebisoy N, Karasoy H, Gonul AS. Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) development after Amanita phalloides intoxication. Acta Neurol Belg 2016; 116:211-3. [PMID: 26292926 DOI: 10.1007/s13760-015-0525-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 08/01/2015] [Indexed: 11/28/2022]
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Dieterich M, Obermann M, Celebisoy N. Vestibular migraine: the most frequent entity of episodic vertigo. J Neurol 2016; 263 Suppl 1:S82-9. [PMID: 27083888 PMCID: PMC4833782 DOI: 10.1007/s00415-015-7905-2] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 09/11/2015] [Accepted: 09/12/2015] [Indexed: 01/03/2023]
Abstract
Vestibular migraine (VM) is the most common cause of episodic vertigo in adults as well as in children. The diagnostic criteria of the consensus document of the International Bárány Society for Neuro-Otology and the International Headache Society (2012) combine the typical signs and symptoms of migraine with the vestibular symptoms lasting 5 min to 72 h and exclusion criteria. Although VM accounts for 7% of patients seen in dizziness clinics and 9% of patients seen in headache clinics it is still underdiagnosed. This review provides an actual overview on the pathophysiology, the clinical characteristics to establish the diagnosis, the differential diagnosis, and the treatment of VM.
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Affiliation(s)
- Marianne Dieterich
- Department of Neurology, Ludwig-Maximilians University, Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany.
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians University, Munich, Germany.
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.
| | - Mark Obermann
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
- Center for Neurology, Asklepios Hospitals Schildautal, Seesen, Germany
| | - Nese Celebisoy
- Department of Neurology, Ege University Medical School, Bornova, Izmir, Turkey
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Guler A, Alpaydin S, Bademkiran F, Sirin H, Celebisoy N. CEREBRAL VENOUS THROMBOSIS AND TURNER SYNDROME: A RARE REPORTED ASSOCIATION. Genet Couns 2015; 26:307-311. [PMID: 26625661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Turner Syndrome is the only known viable chromosomal monosomy, characterised by the complete or partial absence of an X chromosome. It's the most common chromosomal abnormality in females. Apart from the well known dysmorphic features of the syndrome, it has been associated with a number of vascular pathologies; mainly involving the cardiovascular, renovascular, peripheral vascular and cerebrovascular system. It seems striking that thromboembolism is not considered as a feature of the syndrome. Most of the thromboembolism cases are related to the arterial vascular system; except for some rare reported portal venous thrombosis cases, peripheral venous thrombosis cases and to the best of our knowledge a single case of cerebral venous thrombosis with Dandy Walker malformation and polymicrogyria. We herein report a cerebral venous thrombosis case with Turner Syndrome. With no other found underlying etiology, we want to highlight that Turner Syndrome, itself, may have a relationship not only with the cerebral arterial vascular system pathologies but also with the cerebral venous thrombosis.
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Karapolat H, Celebisoy N, Kirazli Y, Ozgen G, Gode S, Gokcay F, Bilgen C, Kirazli T. Is vestibular rehabilitation as effective in bilateral vestibular dysfunction as in unilateral vestibular dysfunction? Eur J Phys Rehabil Med 2014; 50:657-663. [PMID: 24755774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Bilateral vestibular dysfunction causes serious disabilities and handicaps. Patients with bilateral dysfunction often restrict their activities and tend to be unsocial. AIM To compare the effects of vestibular rehabilitation on disability, balance, and postural stability in patients with unilateral and bilateral vestibular dysfunction. DESIGN Retrospective study. SETTING Outpatient rehabilitation center. POPULATION Patients with unilateral (group 1, N.=42) and bilateral vestibular dysfunction (group 2, N.=19). METHODS All patients were evaluated before and after eight weeks of customized vestibular rehabilitation for disability (Dizziness Handicap Inventory [DHI], Activities-specific Balance Confidence Scale [ABC]), dynamic balance (Timed Up and Go Test [TUG], Dynamic Gait Index [DGI]), and postural stability (static posturography). RESULTS The differences between DHI, TUG, DGI, and falling index (as assessed by static posturography) scores before and after the exercise program were statistically significant in both groups (P<0.05). There were no significant intergroup differences in any of the parameters evaluated (P>0.05). CONCLUSION In this study, vestibular rehabilitation was found to be equally effective in unilateral and bilateral vestibular dysfunction patients for improving disability, dynamic balance, and postural stability. CLINICAL REHABILITATION IMPACT Patients with bilateral dysfunction, causing more disability and greater handicap may indeed regain their functions as in patients with unilateral vestibular dysfunction by receiving appropriate and adequate vestibular rehabilitation.
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Affiliation(s)
- H Karapolat
- Physical Medicine and Rehabilitation Department Medical Faculty, Ege University, Bornova, Izmir, Turkey
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Kirazli Y, Karapolat H, Celebisoy N, Kirazli T. No. 173 Is Vestibular Rehabilitation as Effective in Bilateral Vestibular Dysfunction as in Unilateral Vestibular Dysfunction? PM R 2014. [DOI: 10.1016/j.pmrj.2014.08.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Celebisoy N, Kocaman AS, Gulluoglu H, Yuceyar AN, Gokcay F, Kose T. Optic Neuritis: Visual Outcome and Risk Factors for the Development of Multiple Sclerosis in Western Turkey. Neuroophthalmology 2011. [DOI: 10.3109/01658107.2011.580888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gode S, Celebisoy N, Kirazli T, Akyuz A, Bilgen C, Karapolat H, Sirin H, Gokcay F. Clinical Assessment of Topiramate Therapy in Patients With Migrainous Vertigo. Headache 2010; 50:77-84. [DOI: 10.1111/j.1526-4610.2009.01496.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Giray M, Kirazli Y, Karapolat H, Celebisoy N, Bilgen C, Kirazli T. Short-Term Effects of Vestibular Rehabilitation in Patients With Chronic Unilateral Vestibular Dysfunction: A Randomized Controlled Study. Arch Phys Med Rehabil 2009; 90:1325-31. [DOI: 10.1016/j.apmr.2009.01.032] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Revised: 01/06/2009] [Accepted: 01/30/2009] [Indexed: 10/20/2022]
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Abstract
OBJECTIVES To determine the prevalence of headache in patients with primary Sjögren's syndrome (pSS) and to examine the relationship between headache types and clinical, serologic features of the disease. METHODS The study enclosed 133 patients with the diagnoses of pSS and 97 healthy controls. A questionnaire designed to assess the presence of headache and if present to classify it according to the criteria of the International Headache Society was used. RESULTS In 133 of the pSS patients evaluated, 104 had headache. No association was present between types of headache and the clinical and laboratory manifestations of the disease. Both migraine and tension-type headache were more common in patients with pSS when compared with healthy controls (P < 0.001). CONCLUSIONS The high prevalence of migraine in pSS patients might be explained by a vascular headache triggered by immuno-mediated disease activity without an obvious clinic or laboratory marker.
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Affiliation(s)
- F Gökçay
- Department of Neurology, Ege University Medical School, Bornova, Izmir, Turkey.
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Abstract
OBJECTIVES - To assess the efficacy of topiramate in the treatment of idiopathic intracranial hypertension (IIH) and to compare it with acetazolamide. METHODS - Fourty patients diagnosed as IIH and randomly assigned to treatment with either acetazolamide or topiramate were assessed prospectively. Improvement in the visual fields at the end of third, sixth and twelfth months were taken into consideration. RESULTS - The demographic, clinical features and the cerebrospinal fluid (CSF) pressure of the two treatment groups were similar at the beginning of the study. When the follow-up visual field grades were compared with the visual field grades at the beginning of the study in each group a statistically significant improvement was detected with both drugs. When the results of the two treatment groups were compared with each other no statistically significant difference was present. Prominent weight loss was recorded in the topiramate group. CONCLUSIONS - Topiramate seems to be effective in the treatment of IIH. Weight reduction as well as the reduction of the CSF formation is the possible mechanism of action.
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Affiliation(s)
- N Celebisoy
- Department of Neurology, Ege University Medical School, Bornova, Izmir, Turkey.
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Cakir D, Tosun A, Polat M, Celebisoy N, Gokben S, Aydogdu S, Yagci RV, Tekgul H. Subclinical neurological abnormalities in children with celiac disease receiving a gluten-free diet. J Pediatr Gastroenterol Nutr 2007; 45:366-9. [PMID: 17873753 DOI: 10.1097/mpg.0b013e31806907e8] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Because clinically evident manifestations are frequent in adults with celiac disease (CD), we aimed to investigate whether early neurological abnormalities may be detected in children with CD. METHODS Electroencephalography, electromyography, and somatosensory evoked potentials were performed in children with CD receiving a gluten-free diet. RESULTS The neurophysiological tests revealed subclinical neurological abnormalities associated with CD in 3 (11%) of 27 children: 2 had peripheral polyneuropathy documented with electromyography, and 1 had prolonged latencies in somatosensory evoked potential. Magnetic resonance imaging showed abnormalities in 2 (7.4%) of children: pontine demyelinization in 1 and cortical atrophy in the other. CONCLUSIONS Because the rate of neurological problems is increased in children with CD, neurological abnormalities should be carefully investigated early after the diagnosis of CD is made.
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Affiliation(s)
- D Cakir
- Department of Pediatrics, Ege University Medical School, Izmir, Turkey
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Gokcay A, Celebisoy N, Gokcay F, Atac C. Cognitive functions evaluated by P300 and visual and auditory number assays in children with childhood epilepsy with occipital paroxysms (CEOP). Seizure 2005; 15:22-7. [PMID: 16343955 DOI: 10.1016/j.seizure.2005.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2005] [Revised: 10/24/2005] [Accepted: 10/31/2005] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study was planned to evaluate cognitive functions, especially attention and immediate recall, in children with childhood epilepsy with occipital paroxysms (CEOP), by using P300 and neuropsychological tests, which included visual and auditory number assays. Thirty patients with CEOP, ages ranging from 5 to 17 years were enrolled in the study. Twenty-five healthy children were taken as the control group. METHODS Oddball paradigm was used in P300 recordings. The latency and the amplitude of the P300 wave recorded from Cz were taken into consideration. The neuropsychological test battery included visual and auditory number assays. RESULTS P300 latency was significantly longer in the CEOP group (p=0.014). The results of the visual and auditory number assay test showed significant decline in the patient group when compared with the normal controls. CONCLUSIONS Attention and immediate recall deficits as well as prolonged P300 latencies in children with CEOP can be due to an ongoing epileptic activity either influencing the whole brain or only the occipital lobe which can also be involved in the neuropsychological organization of the human cortex. Therefore, children with CEOP should be evaluated with more detailed neuropsychological tests for possible cognitive deficits.
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Affiliation(s)
- Ahmet Gokcay
- Department of Neurology, Ege University Medical School, Izmir, Turkey
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Celebisoy N, Sagduyu A, Atac C. Alexia without agraphia following cerebral venous thrombosis associated with protein C and protein S deficiency. Clin Neurol Neurosurg 2005; 108:52-5. [PMID: 16311147 DOI: 10.1016/j.clineuro.2004.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2004] [Revised: 09/13/2004] [Accepted: 11/03/2004] [Indexed: 10/26/2022]
Abstract
A 26-year-old right handed female was admitted to hospital with right homonymous hemianopia associated with alexia without agraphia. Her cranial magnetic resonance imaging and magnetic resonance angiography revealed a left occipital venous infarction due to thrombosis of the left transverse, sigmoid sinuses and the left internal jugulary vein. The underlying conditions were protein C and protein S deficiency associated with the use of oral contraceptives. To our knowledge, alexia without agraphia has never been described due to a venous infarction associated with hereditary thrombophilia in the literature.
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Affiliation(s)
- Nese Celebisoy
- Department of Neurology, Ege University Medical School Hospital, Bornova, Izmir, Turkey.
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Abstract
PURPOSE The authors wished to evaluate the effectiveness and safety of retroequatorial recession of all four horizontal recti using loop sutures for the treatment of congenital nystagmus SUBJECTS AND METHODS Twelve patients with congenital nystagmus were enrolled in this prospective study. All patients underwent retroequatorial recession of horizontal recti with loop sutures. All recti were recessed 8 mm measuring from the insertion, then the amount of loop suture was determined according to the preoperative ocular alignment of the patients. Electronystagmographic recordings were made in every patient preoperatively and postoperatively as well as an ophthalmological examination. The follow-up period ranged from 6 to 26 months. RESULTS All four horizontal recti were recessed 9 to 12 mm including the loop suture (range 1-4 mm). Compared to preoperative values, postoperative amplitude and intensity of nystagmus decreased statistically significantly in all patients (p = 0.002). The postoperative decrease in the frequency of nystagmus was not statistically significant (p = 0.173). Improvement of both distance and near visual acuity was achieved in 10 patients. Five of seven patients who had ocular misalignment preoperatively were aligned within 10 PD postoperatively. Improvement in head posture was seen in two of three patients. The authors determined that the improvement in the nystagmus characteristics was most prominent in the immediate postoperative period. CONCLUSION Retroequatorial recession of all four horizontal recti using loop sutures is a safe and effective procedure for the management of congenital nystagmus.
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Affiliation(s)
- Süheyla Köse
- Department of Ophthalmology, Ege University Faculty of Medicine, Izmir, Turkey.
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Abstract
OBJECTIVES Pseudotumor cerebri (PC) is a clinical condition characterized by signs and symptoms of increased intracranial pressure, such as headache and papilledema. MATERIAL AND METHOD A total of 62 patients diagnosed with PC, who were on follow-up for a period ranging from 4 to 60 months, were investigated retrograde from 1990 to 1998 and then anterograde from 1998 to 2001 to find out the etiological factors, symptoms and signs and the prognosis in the western part of Turkey. RESULTS There were 47 (76%) women and 15 (24%) men. The age of onset of symptoms was 32.7 +/- 9.9 (range 18-56) years. Obesity was found in only 17 (30%) of them. There were eight patients (13%) with venous sinus thrombosis causing PC. Five patients (8%) had Behçet's disease. The most common symptom was headache, recorded in 93% of the patients, which was followed by transient visual obscurations (60%). Snellen visual acuity was disturbed in 17 patients (27%) at the initial visit. Visual loss determined by automated perimetry was present in 71% of the cases. Three patients (3%) became blind in both eyes. Of the 62 patients, 41 were on follow-up during the study. Twenty-one (51%) showed regression of the visual field grade, nine patients (22%) worsened and 11 (27%) were stationary. CONCLUSION Obesity was not as frequent as reported in western countries but Behçet's disease was found to be a frequent cause. Perimetry was the most reliable method to follow-up the patients.
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Affiliation(s)
- N Celebisoy
- Department of Neurology, Ege University Medical School Hospital, Bornova, Izmir, Turkey.
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Abstract
In the current study, the effects of stimulation of the infraorbital nerve (ION) on the trigeminocervical reflexes (TCRs), recorded from the posterior neck muscles, was investigated and the results were compared with the results recorded by stimulation of the supraorbital nerve (SON). TCRs obtained by stimulation of the ION was evaluated as the electrophysiologic counterpart of the head retraction reflex. Twenty normal control subjects, 10 men and 10 women, were enrolled in the study. The SON and the ION were stimulated by using a bipolar surface electrode. Results were recorded by using either concentric needle electrodes inserted into the semispinalis capitis muscle at the level of the third or fourth cervical vertebra or by surface electrodes placed at the C3 and C7 vertebrae on the midline. It was found that stimulation of the supraorbital and infraorbital branches of the trigeminal nerve had different reflexive effects on the posterior neck muscles. A stable positive (or negative-positive) wave, with a very early latency and high amplitude was always recorded after maximal stimulation of the ION, which could never be detected by stimulation of the SON. The C3 response of the TCR, evoked by SON stimulation was always evoked, by stimulation of the ION, at a low threshold. These findings suggest that the head retraction reflex is composed of two phases: inhibitory and excitatory. The early, fixed positive wave represents the general inhibition of the cranial and neck muscles, just before withdrawal of the face and head, from unexpected stimuli, which precedes the dense C3 response, demonstrating activation of the posterior neck muscles.
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Affiliation(s)
- C Ertekin
- Department of Neurology, Medical School Hospital, Ege University, Bornova, Izmir, Turkey
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Ozsener S, Terek MC, Saydam G, Celebisoy N, Oztekin K, Ozkinay E. Intracranial venous thrombosis associated with severe antithrombin-III deficiency in pregnancy. J Obstet Gynaecol Res 2001; 27:81-4. [PMID: 11396643 DOI: 10.1111/j.1447-0756.2001.tb01225.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report a patient with intracranial venous thrombosis in the third trimester of pregnancy associated with severe antithrombin-III deficiency. The evaluation of protein C, protein S and antithrombin-III levels in patients with thrombotic events during pregnancy may reveal the specific cause of the thrombotic event and thereby influence patient management
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Affiliation(s)
- S Ozsener
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey
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Celebisoy N, Varolgüneş N, Akyürekli O. Corneal reflex and blink reflex changes in thalamic hemorrhage. Electromyogr Clin Neurophysiol 2000; 40:95-102. [PMID: 10746185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
We studied the corneal reflex (CR) with air-puff and direct touch by using a standardized method in patients with thalamic hemorrhage (TH) (n: 15) and in normal control subjects (n: 21). The conventional blink reflex (BR) was also studied. In the TH group: 1--When the cornea on the clinically nonaffected side was stimulated the corneal reflex responses were elicited bilaterally, with normal latency on the clinically normal side and delayed on the affected side. 2--When the cornea on the clinically affected side was stimulated, the corneal responses on both sides were either abnormal or could not be elicited. 3--The ipsilateral R1 and R2 responses recorded by stimulation of the supraorbital nerve on the clinically affected side were abnormal where the contralateral R2 responses were in the normal range. In the normal control and TH groups: 1--No statistical difference could be detected between the responses elicited by air-puff or direct touch to cornea (p > 0.05). 2--CR responses were statistically different from the R2 response of the BR (p < 0.005).
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Affiliation(s)
- N Celebisoy
- Ege University Medical School, Department of Neurology, Bornova, Izmir, Turkey
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Varolgüneŝ N, Celebisoy N, Akyürekli O, Pehlivan M, Akyürekli O. Analysis of the corneal reflex with air puff: normal controls and patient groups. J Clin Neurophysiol 1999; 16:472-83. [PMID: 10576230 DOI: 10.1097/00004691-199909000-00009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Though there are several reports published about the corneal reflex elicited by different methods, a standardized electrophysiologic study with air puff in man has not been published. The aim of this study is to standardize the corneal reflex elicited by air puff to cornea. The authors studied the corneal reflex with air puff and direct touch by using a standardized method in patients with thalamic hemorrhage (n = 15), hemispheric infarction (n = 9), brainstem infarction (n = 9), multiple sclerosis (n = 12), and Bell's palsy (n = 12) and in normal control subjects (n = 21). The conventional blink reflex (BR) was also studied. The reflex responses were recorded from both orbicularis oculi muscles by air puff and direct touch to cornea in addition to the electrical stimulation of the supraorbital nerve. No statistical difference could be detected between the responses elicited by air puff or direct touch to cornea (P > 0.05). Corneal reflex responses were statistically different from the R2 response of the BR (P < 0.005). Because the responses elicited by direct touch and air puff to cornea are identical, air puff to cornea can be used confidently to study the corneal reflex.
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Affiliation(s)
- N Varolgüneŝ
- Ege University Medical School, Department of Neurology and Biophysics, Bornova, Izmir, Turkey
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Cetingül N, Aydinok Y, Kantar M, Oniz H, Kavakli K, Yalman O, Erermiş S, Celebisoy N, Akyürekli O, Oztop S, Nişli G. Neuropsychologic sequelae in the long-term survivors of childhood acute lymphoblastic leukemia. Pediatr Hematol Oncol 1999; 16:213-20. [PMID: 10326219 DOI: 10.1080/088800199277263] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The neurotoxicity of either systemic chemotherapy or central nervous system prophylaxis was studied in 19 children treated for acute lymphoblastic leukemia (ALL). They had completed ALL therapy at least a year before and survived more than 5 years after diagnosis. The duration between age at diagnosis and age at investigation was 8.6 +/- 2.7 years (5-15 years). Neuropsychologic tests, cranial magnetic resonance imaging (MRI), and evoked potentials (EP) were studied. Seventeen healthy siblings were taken as a control group. Emotional evaluation was done using the childhood depression inventory and Beck depression inventory. Cognitive functions were evaluated using Wechsler's Intelligence Scale for Children-Revised (WISC-R) or the Wechsler's Adult Intelligence Scale-Revised (WAIS-R) tests, which were adapted to Turkish children. Performance and total IQ scores (94.0 +/- 16.8 and 92.2 +/- 16.5) were significantly low as compared to the control group (112.1 +/- 18.9 and 105.4 +/- 14.2) (p = .007 and p = .02). Abnormal MRI findings were found in 33.3% (6/18). Three out of 18 patients (16.6%) had abnormal auditory while 5 out of 17 patients (29.5%) displayed abnormal visual EPs. Abnormal findings in MRI, cognitive examination, and electrophysiologic testing were not associated with age at diagnosis, radiotherapy doses, intermediate/high-dose systemic methotrexate administration or central nervous system involvement. But more patients must be studied to demonstrate discrete outcomes of neurotoxicity in long-term survivors of childhood leukemia.
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Affiliation(s)
- N Cetingül
- Ege University, Faculty of Medicine, Department of Paediatrics, Izmir, Turkey
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Abstract
A case is reported of the continuous muscle fibre activity syndrome, which includes a group of disorders characterised by sustained motor unit activity due to hyperactivity of peripheral nerve motor axons. In this patient the muscle stiffness and myokymic movements were successfully treated with acetazolamide, which acts as a membrane stabiliser either by blockade of chloride and bicarbonate membrane transport or by producing kaliuresis and raising the transmembrane potential by decreasing extracellular potassium.
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Affiliation(s)
- N Celebisoy
- Ege University, Faculty of Medicine, Department of Neurology, Bornova, Izmir, Turkey
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Abstract
OBJECTIVE The protective effect of aprotinin, which is a protease inhibitor, was assessed in a rabbit spinal cord ischemia model. DESIGN Randomized, controlled, prospective study. SETTING University research laboratory. SUBJECTS New Zealand white rabbits (36) of both sexes. METHODS In 24 animals, ischemia was induced with midline laparotomy and clamping the aorta just distal to left renal artery and proximal to aortic bifurcation for 20 min. Aprotinin was given 30000 KIU as a short intravenous injection after anesthesia, and was followed by 10000 KIU/h by continuous infusion in group 1 (n = 12). Similar volume of saline solution was used in control group of animals (group 2, n = 12). Group 3 of animals (sham group, n = 12) were anesthetized and subjected to laparotomy without aortic occlusion. Physiological parameters and somatosensory evoked-potentials (SEP) were monitored in animals before ischemia, during ischemia and in the first 60 min of reperfusion. Their neurological outcome was clinically evaluated up to 48 h postischemia. Their motor function was scored, and the intergroup differences were compared. The animals were sacrificed after two days of postischemia. Their spinal cord, abdominal aorta, and its branches were processed for histopathological examination. RESULTS In group 3, SEP amplitudes did not change during the procedures, and all animals recovered without neurologic deficits. At the end of ischemic period, the average amplitude was reduced to 53+/-7% of the baseline in all ischemic animals. This was followed by a gradual return to 89+/-8 and 81+/-13% of the initial amplitude after 60 min of reperfusion in group 1 and group 2 correspondingly (P > 0.05). The average motor function score was significantly higher in group 1 than group 2 at 24 and 48 h after the ischemic insult (P < 0.05). Histological observations were clearly correlated with the neurological findings. CONCLUSION The results suggest that aprotinin reduces spinal cord injury and preserves neurologic function in transient spinal cord ischemia in rabbits.
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Affiliation(s)
- B H Sirin
- Department of Cardiovascular Surgery, Pamukkale University Hospital, Denizli, Turkey
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